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Home My WebLink AboutBLDDG-22-000599 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :1;SI CITY 'YARMOUTH MA DATE 'August 03,2021 PERMIT# BLDG-22-000599 Ir_ JOBSITE ADDRESS 1101 SISTERS CIR OWNER'S NAME David Whalen G OWNER ADDRESS MA 02637 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT YES ❑ NO❑ CLEARLY NEW: CI PLANS SUBMITTED: RENOVATION:0 REPLACEMENT:0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME (Robert Lalime 'LICENSE# '13701 I SIGNATURE MP© MGF 0 JP❑ JGF❑ LPG' 0 CORPORATION❑#I I PARTNERSHIP ❑#I ILLC ❑#I I575 Main St , COMPANY NAME: IROBERT C LALIME ADDRESS. I CITY IMashpee I STATE IMA I ZIP 1026492054 I TEL I FAX 1 1 CELL 1 1 EMAIL 'none MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK et I CITY :--tri -0 L i - MA DATE V (^ PERMIT# 22- cg 9 JOBSITE ADDRESS' Tail TSt St- Ct It I:OWNER'S NAME f'�.4,.,-i ds w F-t 1 Cd',A- OWNER ADDRESS i -Ii-AA 1 I TEL I FAX` E TYPE OR OCCUPANCY TYPE COMMERCIAL;] EDUCATIONAL D RESIDENTIAL` . PRINT CLEARLY NEW: RENOVATION:_J REPLACEMENT: -1 PLANS SUBMITTED: YES D NO L APPLIANCES 7 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _______I ' I__ _i 1_I_____I_Li___J-J___J_J,. I _ I _ I BOOSTER ._I- I; I t _ —I I I. . . I CONVERSION BURNER _J fi.__I_I I I____1!_______I ____.1'_______I -J—1—1 I I COOK STOVE ,._-_____J__LU--t'—.J—i—J:=:___1--f1 U'—J _-__-___11 DIRECT VENT HEATER —r J—J ._ I--1__J :Li —I-______I: I I DRYER __.. ' —_i— !—J I L.—i—€ I I .. i .. I I FIREPLACE �_JJ_ J_ J 1_J I____-1 t_-1___J_._... ! — --I__J__..1 I FRYOLATOR I i_1.—s:_-1_.__I I _ _ I._ __I-_I �I J _. __I _ 111) FURNACE ._j—I-J�:._:_—_1. f 1-_� I 1 !—J J— E I ► GENERATOR I I ... _ f.. J 1 I a. ! I GRILLE _.__-I I_I _ 1 i I_J_____I !- I_Li_._-I°-_.I 1 1 INFRARED HEATER _i h—I.-1 `•-_J__J:_ I _ !—1 —J—1_—J ``• LABORATORY COCKS I .___ _i I.__._-J__._i _ 1 I. J-----I:.__..._1_LI_ J--—1 1 it - - ___.1 _.__I . I i i I�____i._ J MAKEUP AIR UNIT I ',�I__J___rI,_ OVEN - f I '_I__! . _ 1 I . ! I _.__._I___I I I I POOL HEATER __J_____I I I I _I I, I I_I_____I . . I. I. 1 I ROOM I SPACE HEATER _._._I 1_ - ! I. I F !. — ' 1 1 1 4 a ROOF TOP UNIT •I ! - _ r — I I_J I�J I :I: I I TEST ___I I I _ t I ___I--. I I i. I I_ _ 1 i UNIT HEATER 1 i UNVENTED ROOM HEATER _J: .1 ! I 1_._--i __.J_—J_._J I—___-_.J_I ._..,—__ I WATER HEATER. . ------ —..._: ' •I I I I�_J__J r___._1 I__ J I I. I I OTH ER : I__ _.1 i i ._ 1 I_I I- J____—J _ _ J__ _I 1 1 I I I 1 ___i 1 _i_._.J I 1___I I I__J 1____J.__._.I 1 i____ .I . r I i i ; l J- II z _I---i I i i t I.�._,. if t _E INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I' [NO ,1. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _ OTHER TYPE INDEMNITY .J BOND IIJ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER '_1 AGENT SIGNATURE OF OWNER OR AGENT .-- I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate pith .-st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Vert, provision of the Massachusetts State Plumbing Code and Chapter;42 of the General Laws. PLUMBER-GASFITTER NAME a C (A Lt fr( 1LICENSE#T 37 / ✓ ATURE MP it MGF` I JP • JGF LPG' D. CORPORATION••J#' [PARTNERSHIP Lie I LLC: #: COMPANY NAME:^0�- L L/1Ut,�.6 t W&— I ADDRESS -S 15i 4-t- -- 5-- -----...____.....--I. CITY LM I�`� j2c'65 - I. STATE-WA I ZIP~0 ITEL --Z. -6...„---- . 3 FAY I CFI I; I EMAIL: RECEIVED- ._ JUL 2 9 2021 � � BUILDING DEPARTMENT ("W,- - -ll `CV.)